Falsifiable

Overview

Falsifiable refers to the ability for a proposition to be tested and shown to be false.

For instance, page 58 of the Alcoholics Anonymous Big Book states “Rarely have we seen a person fail who has thoroughly followed our path,” which is also part of the conventional preamble before meetings. This is unfalsifiable: if someone has remained sober while working the program, it’s proof of the success, but if someone continues drinking, it means they didn’t work the program thoroughly enough. Under this unfalsifiable statement, the program’s effectiveness cannot be challenged through empirical evidence.

History and Etymology

Commentary

A big problem in recovery is that repetition of unfalsifiable cliches or paradigms that lead to continual self-blame rather than practical reforms. Some of these include:

• “Your best thinking got you here.” Well, duh, you can’t use anyone else’s thinking except your own. You can take suggestions, but it’s your own thinking that will decide to take them or not. This phrase is generally used as a response to challenges

• “It’s not a drinking problem, it’s a thinking problem.”

It can be both, or both can be part of a bigger overarching problem. If we use the widely accepted biopsychosocial model of individual health, there are structural changes caused to the brain from chronic substance use that you cannot reverse simply by following different thought patterns. That’s why behavioral interventions like Behavioral Activation (BA) and Contingency Management (CM) are so effective compared to Cognitive-Behavioral Therapy (CBT) which focuses on challenging cognitive distortions and irrational thinking.

• “It’s not a religious program, it’s spiritual.”

This is one of those statements that might make sense if you come from a background with a hierarchical religious organization, as many Christian families do. It makes less sense if you come from a background with a decentralized syncretic belief system, as many Hindu and Buddhist families do. Devout Hindus do not necessarily have the same mandates to attend organized practices or rituals, and where it does happen, it’s often for the sake of community integration rather than personal belief systems. Also, even within the American legal system, courts have ruled consistently that AA at least includes “general religious content” such that it cannot be mandated as part of a legal punishment without violating the Establishment Clause of the U.S. Constitution.

• “You have a case of terminal uniqueness.”

If you claim there’s something unique about your situation that isn’t being factored into a discussion, you can get hit with this dismissal. Arguably, this is in the interest of uniformity and solidarity, but in the same way that every shape can fit into a square peg once you cut enough of it off. It begins with a conclusion and dismisses details that challenge its fundamentals, rather than considering all the details and drawing a conclusion that’s consistent with those details.

Also, while the U.S. Census Bureau estimates that 60% of the population is white, AA’s internal tracking shows that it consistently hovers around 88% white. 86% identify as Christian, with 84% saying they had a pre-existing belief in God beforehand, and the vast majority explicitly use God or Jesus Christ as their Higher Power. The average age of an AA member is 50, with 74% of the organization being over the age of 40. 62% of the members identify as men. 26% have a Bachelor’s degree or higher compared to 35% of the general public. To be blunt, or rather, rigorously honest, this is not a diverse organization. Its culture is rooted in the mid-20th century social networks of white middle or upper class Christian professional men who became skeptical of corporate bureaucracy, medical institutions, and the government. They worked on Wall Street, had surgical practices, led high-powered sales careers, etc. These were people who had immense privilege and opportunity but squandered it in the course of their drinking, not people who had struggled their whole lives against systemic barriers that have nothing to do with their individual conduct.

I’ll simplify my point: the vast majority of people who use this phrase about “terminal uniqueness” cannot describe at a basic level Hinduism, Buddhism, Taoism, Shintoism, or any of the belief systems practiced by billions of people across the ocean. I don’t think you can claim people are all fundamentally the same when you don’t actually understand people who didn’t grow up in the same culture and community as you.

• “Once an alcoholic, always an alcoholic. This disease is doing push-ups in the parking lot.”

Substance use disorders are generally considered chronic health conditions that are progressive if left untreated. However, a significant number of people who once met the criteria for a substance use disorder eventually don’t, whether it’s the result of abstinence or low-risk moderation. If someone in that category relapses after 30 years, this adage is used to argue that the disease of addiction was always building in the background, and the only way to ward it off is constant hypervigilance that weaves the rituals of AA into daily life. A lot of Americans may not realize how rooted in Protestant theology that is. Early American Puritanism framed the Devil as a constant threat lying in wait behind every daily temptation. To combat this threat, people needed to be engaged in constant spiritual warfare against the “cunning, baffling, powerful” enemy.

“Everything happens for a reason.”

This one is easy to see as unfalsifiable. Either you can find a reason that fits into your worldview, or you can assume one exists but you haven’t found it yet. There’s no way to prove that something happened for no reason.

As humans, we really want to believe this, because the notion of a random universe that is indifferent to our experiences can be scary. It’s much more comforting to imagine there’s a plan or a reason we just aren’t aware of, and some entity with more knowledge and power than us, who cares about us, is administering it. I’m not attempting to discourage religious belief with this, as I do think there are religious philosophers who have a more consistent and coherent worldview than me and I couldn’t claim to refute theirs. I’m just focusing on the way this is thrown around in isolation as a cliche that essentially dismisses the very genuine and valid feelings someone has who believes in a random or indifferent universe.

Lest you think I’m singling out A.A. or Abrahamic religious systems, here are some from contemporary traditions in psychology and psychiatiry:

• “You’re being defensive and resisting the process.”

This can come up in the context of Cognitive-Behavioral Therapy (CBT), where therapists often deliver worksheets or curriculums from manualized intervention protocols intended to develop coping skills. If these don’t align with the patient’s experience, there is no way to falsify the effectiveness of the tool. If the patient agrees with the therapist’s assessment, the intervention works. If the patient is reporting that the coping skills either don’t work or aren’t making sense, the therapist can interpret this as resistance or defensiveness, which is just proof that there’s a deeper truth the patient is avoiding but the therapist must elucidate.

• “If you claim to have tried Cognitive-Behavioral Therapy and don’t think it works, tell me about the cognitive distortions and core beliefs you’ve challenged before with the tools.”

I’m unsure how someone is supposed to report their own cognitive distortions, because if you recognize something is a distortion, you don’t really have the distortion anymore. If you’ve challenged your core beliefs, you’ve likely reevaluated them into new or modified versions of the core belief. And if neither of those were really your problem to begin with, you simply have nothing to report, which is then seen as proof you didn’t really do CBT correctly. The premise behind this line of argument is that the professional therapist is guaranteed to find distortions or dysfunctional core beliefs if they look hard enough, so a lack of distortions is only proof of a lack of CBT.

It becomes very difficult for anyone to express that CBT isn’t addressing their problems or aligns well with them, especially since general psychoeducation classes are often just rehashed CBT modules with a group-discussion component. If you complete every worksheet and assignment provided by a CBT practice, but still remain depressed or chronically stressed, the only lever CBT provides is that you haven’t adequately challenged enough distortions to uncover the true core beliefs at the root of your suffering. In this way, we essentially have recreated the Christian confessional model of counseling. If you’re suffering, it is because of some sin or flawed core belief that has not been confessed, and the role of the authoritative expert is in eliciting this confession and sorting it into a narrative to change the individual’s conduct. To challenge the ideological underpinnings of CBT in this situation is akin to questioning the existence of God in a confessional booth.

Even if you succeeded in presenting the argument and gained a concession, what have you actually accomplished except upsetting someone with significant control over labeling you as non-compliant? In moments when I’ve completely rationally explained my situation, my reaction, my past distortions and beliefs and how I’ve changed, I’ve literally been asked by a therapist: “so what’s the problem? Why are things going wrong?” Buddy, that’s what I’m fucking paying you to figure out.

Thankfully, I did encounter another therapist who, at the very first session, broke down the difference between insight and capacity, noticed I didn’t struggle with insight into myself but executive dysfunction from co-occurring disorders, and quickly facilitated further evaluation.

• “You need to accept that sometimes in life we are going to be overwhelmed and distressed, but we shouldn’t catastrophize about them or try fortune-telling.”

This one is profoundly condescending. A therapist has an extremely limited ability to assess a patient’s life outside of the short hour-long sessions in which they try to communicate their perspective from their lived experiences. Dismissing a patient’s reasonable concerns about a potential catastrophe as low distress-tolerance and rational capacity to assess future risk is incredibly damaging.

In my own case, I’ve had a therapist condescendingly retort that I don’t understand the job market because “you’re 25” when I was referring to a type of job I’ve done for over a decade - longer than they said they had been a therapist. They also thought that I was in too much of a rush to apply for jobs that I knew could take weeks to arrange, reflecting a fundamental out-of-touch perspective that they reiterated often with derogatory remarks about “young people these days” lacking in work ethic. There was no way for me to falsify any of their positions. If I argued that my concerns about sustainable employment in the face of managing new health conditions and a volatile job market were justified, the therapist would read that as resistance to having my cognitive distortions challenged. As I said above, there is no lever that says “your disturbance in response to the circumstances of your life are completely rational and systemic reform is necessary to change those circumstances.”

I credit that experience with helping me feel vindicated in critiquing therapeutic modalities and institutions. The heavy emphasis on individual therapists to determine someone else’s rationality or cognitive distortions invites subjectivity that can be deeply harmful.